Abdominal sonography predicts need for surgery in blunt trauma patients

Hypotensive patients with blunt abdominal trauma could skip the CT in the emergency department and go directly to exploratory laparotomy when they have positive focused abdominal sonography for trauma (FAST) findings, according to researchers from the University of California, Davis.

Brett C. Lee and colleagues analyzed medical records of more than 4000 emergency room patients with blunt abdominal trauma over six years. They divided the patients into two groups - hypotensive and normotensive - and performed FAST on all 4029 patients. Of 122 hypotensive patients, 87 had positive findings on FAST, and 69 of them (79%) were taken directly to exploratory laparotomy and did not require CT to determine a need for the surgery.

FAST produced 85% sensitivity, 60% specificity, and overall 77% accuracy in predicting need for exploratory laparotomy.

The researchers compared these results with the 3907 blunt abdominal trauma patients who were normotensive on arrival. Only 323 patients in this group had positive FAST findings. FAST produced 85% sensitivity, 96% specificity, and overall accuracy of 96% in evaluating these patients for laparotomy.

Across the two populations, FAST had an overall accuracy of 95% in predicting need for laparotomy. The researchers concluded that positive FAST findings for hypotensive patients screened in the ER were sufficient to triage them directly to laparotomy without the need for CT.